A Medical Economics Web Exclusive

Flashback in Medical Economics

25 years ago: 1976

"Is the Doctor Union Movement Dead?" our cover story asked. From the evidence we’d gathered, the answer looked to be Yes. Consider:

• The specter of national health insurance–which had loomed large in the early 1970s–was fading. With no great threat out there to unify doctors, membership in the country’s four major physician unions began falling.

• Even the most zealous of unionists had to admit that nationwide, no more than 40,000 private physicians were formally organized. And that was a soft number, at best: It included members of unions that existed mainly on paper and hadn’t actually done anything, doctors who’d returned a membership form but hadn’t yet paid their dues, and doctors who were counted twice or three times because they’d signed up with more than one union.

• The American Medical Association was becoming more hard-nosed as it pressed doctors’ national agenda–to the point of filing a number of lawsuits against the federal government and various third parties. This increased militancy drained support from physician unions. Ironically, most observers cited the growth spurt among doctor unions in the ’60s and early ’70s for compelling the AMA to toughen its efforts.

Physician unions claimed some victories of their own. Among them: In California, a union lawsuit led to reinstatement of hospital privileges for doctors who wouldn’t buy malpractice insurance. In Florida, another union claimed credit for persuading the state to start a "defense insurance fund" to protect physicians who had dropped malpractice coverage, and for achieving a 32 percent boost in workers’ compensation payments to doctors. In Texas, a doctor union created its own liability insurer.

Still, insiders from politics, organized medicine, and the labor movement were pessimistic about the future of physician unions. "[They] take credit for every favorable event since Magna Carta," scoffed one medical society official.

Over the next two decades, the doctor union movement slipped almost totally off the radar. Then, in the late 1990s, it re-emerged as physicians chafed under the clamps of managed care. More than 45,000 physicians were organized nationwide, a surge due largely to the fact that so many of today’s doctors are employees, not owners of practices. Even the AMA formed and funded a union called Physicians for Responsible Negotiation.

Recently, however, the US Supreme Court dealt the movement a severe blow. The justices ruled that nurses who oversee less-skilled workers at a facility for the developmentally disabled are supervisors, not employees, and therefore aren’t protected by the National Labor Relations Act. That ruling, many experts say, also casts serious doubts on doctors’ right to bargain collectively.

50 years ago: 1951

This essay by Faye C. Lewis, MD, took up less than a single page. In its own way, though, it spoke volumes:

Yes, Doctor, No, Doctor

The other evening I was talking to a woman who had been head librarian at a nationally known clinic. I asked her how she had happened to give up her job. Her reason was the constant "Yes, Doctor, No, Doctor" she had heard on every hand. It was more than she could stomach.

I couldn’t help agreeing. For the incessant use of the title "Doctor" is at once pointless, tiresome, and in poor taste.

Why on earth do we insist on it, anyway? Look at the kettle of fish it puts us with. When someone calls us "Doctor," we may be any one of a dozen things, from a PhD to a sanipractor. In my town it even designates a retired blacksmith, whose "degree" stems from an inspiration to heal, and nothing else.

Since the title has been so diluted, then, why not leave it in the hands of the adulterators and come clean ourselves? No person of real substance needs a title to lean on. Did the word "Doctor" ever do anything for Osler or Einstein? Is it any guarantee of superior intelligence? (What a huge laugh that would be to the girl who untangled my checkbook for me last week.) It can scarcely be a symbol of prestige, exacted as it is from the public in so wholesale a manner. And of what value is prestige, anyway, except that it comes from individual integrity and accomplishment?

This is not a new idea, of course. The British have gone quite a way with it; others here have thought about it, too.

I’m told that the chancellor of one of our leading universities has asked that the title "Doctor" no longer be used by members of his faculty–the reason being that on any good university faculty a degree is something to be taken for granted, not something to be sounded off at the drop of an ego.

Just call me Mrs. Lewis.

With pleasure, Mrs. Lewis.–The Editors (50 years later)

75 years ago: 1926

"Nearly every doctor has had the experience of being interviewed by a security salesman, and of being urged to make an investment in the securities of such-and-such a company."

If the pitch came from someone known and trusted, Medical Economics acknowledged, he’d have earned credibility. But to arm our readers of the ’20s against smooth-talking strangers, we published "Ten Questions to Ask a Security Salesman." The questions, supplied by New York City’s Better Business Bureau:

1. What are the names and principal address of your employers, and how long have they been in business?

2. With what bank does your firm do business, and what are its other references?

3. What is the net worth of the company in which stock is being sold, and the date of its organization?

4. What are the company’s liabilities?

5. What are its earnings?

6. How many times has interest or dividends on this security been earned in the past five years?

7. Who are the company’s officers, and what is their record of business activity in the past five years?

8. What experience have these officers had in the business in which the company is engaged?

9. Is this security accepted as collateral for loans at banks?

10. What is the market for this security in the event I want to dispose of it?

"There is nothing in the foregoing list of questions that any salesman of a legitimate security may properly refuse to answer," we advised doctors. "The information requested is only that which any sensible person ought to know before putting his money into a company."

Of course, it wasn’t enough just to ask the questions and have them answered by the salesman. Before buying the stock, the doctor had to confirm the answers with a trusted source. Seventy-five years ago, our recommendation was "your local banker." Remember, this was before the day of personal financial advisers in every city, money-management columnists and magazines, and online research services. It was also before so many banks became impersonal behemoths.

—James D. Hendricks
Executive Editor

James Hendricks. Flashback in Medical Economics.

Medical Economics

2001;18.